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Papilloedema
Sharpness of vision stays normal for a long time while the field shrinks from the outside — judging by reading underestimates the situation.
Also known as: papilledema · sign of raised intracranial pressure
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Papilloedema is not an eye disease but an imprint: the pressure inside the skull is raised and backs up into the head of the optic nerve, which swells as a result. Because the pressure fills the whole head, it is almost always on both sides. The treacherous part is that sharpness of vision stays normal for a long time — one still reads the smallest line while the field of vision is already shrinking from the outside in. Anyone relying on reading therefore underestimates the situation. The typical companions are headaches that are worse lying down and in the morning and increase on coughing or straining, along with nausea, double vision and a noise in the ear that rushes in time with the pulse. Very characteristic are brief moments in which, on standing up or bending, everything goes grey for seconds and then returns. The causes range from a mass to a thrombosis of the brain veins to a rise in pressure with no graspable cause, which affects above all younger women with overweight and in which weight loss genuinely changes the course. Medicines also come into question. Assessment is always urgent, and imaging comes before measuring the pressure.
Reading well does not here mean the eye is safe. What counts is the field of vision — and that is measured, not estimated.
A mass and a thrombosis of the brain veins have to be excluded before the pressure is measured by a puncture. This order is not a formality.
The course is judged by the field of vision, not by how one feels. Regular measurements show early whether the treatment is enough.
Certain antibiotics of the tetracycline group, high-dose vitamin A, acne medicines and some hormone preparations can raise the pressure. Stopping belongs discussed, not decided alone.
A weight loss of about a tenth lowers the pressure measurably and is, in this form, one of the few measures that genuinely change the course.
A new headache that is worse lying down, together with brief visual blackouts, double vision or vomiting, belongs looked at the same day.
Acetazolamide lowers the making of the fluid around the brain and with it the pressure; it works over weeks and causes tingling in the fingers and an altered taste. What achieves the larger part when excess weight is behind it is weight: five to ten per cent less lowers the pressure measurably. What no drug does: rule out a mass — which is why imaging comes first. With threatened loss of sight, the nerve is decompressed or a shunt is placed.
The pressure of the fluid around the brain is normally under 25 centimetres of water; above that it counts as raised. The passing visual disturbances last seconds and come on bending or standing. From the rise in pressure to visible swelling, hours to days pass — and after the pressure falls, the swelling needs six to eight weeks to recede. The idiopathic form affects mainly women between twenty and forty with excess weight.
Strongest in the morning, increasing on coughing, sneezing or straining. That separates it from most other headaches, which improve on lying down.
On standing up or bending the picture briefly disappears and returns. This sign is very characteristic and is almost always put down to circulation.
A noise in the ear heard in time with the heartbeat. In this combination it is a serious pointer and not an ordinary tinnitus.
The nerve for the sideways movement of the eye has the longest course and suffers first when pressure rises. It says nothing about where the cause sits.
The commonest constellation in raised pressure with no graspable cause. Certain antibiotics, high-dose vitamin A and acne medicines are among the known triggers.
Not for the diagnosis. They help to separate an inflammatory cause and, in later life, giant cell arteritis, which damages the nerve by a different route.
A marked anaemia and certain blood disorders can accompany swelling of the optic nerve heads. A simple value that opens a rare trail.
A very high blood pressure can also make both optic nerve heads swell. That form is an emergency of its own and is recognised through the blood pressure, not through the eye.
These two pigments gather exactly at the place of sharpest vision and filter short-wave light there. Kale, spinach, chard, broccoli and egg yolk are the sources.
The retina holds particularly much zinc; it is needed to turn light into a signal. High doses over months lower copper, though — so the two are considered together.
The outer segments of the seeing cells consist largely of a long-chain omega-3 fatty acid, and the tear film needs it too.
The seeing pigment is built from vitamin A. A lack shows first as poor vision at dusk and as a dry surface of the eye.
The one point that really counts here: high doses of vitamin A and its relatives can raise the pressure inside the head and produce exactly this picture. With cod liver oil, high-dose A preparations and acne medicines from this substance group, it is to be asked about before searching further.
No connection with the pressure inside the head. What matters is the mix-up: cod liver oil contains both, D and A — and it is the A in it that matters here.
Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.
Stopping cortisone abruptly after longer use can let the pressure in the head rise. That is one of the reasons cortisone is tapered rather than broken off.
Too much vitamin A is among the known triggers of raised pressure in the head — as a high-dose supplement or as an acne medicine. Vitamin D is not; the two are occasionally mixed up here.
In raised intracranial pressure without a tumour excess weight is the main modifiable factor. Losing 5–10 % lowered the pressure and improved vision in studies — here diet is part of the treatment.
Here as a warning: very high vitamin A doses and certain acne medicines from the same substance group can themselves raise intracranial pressure. With this finding the list of preparations belongs reviewed.